Objective:To analyze immune reconstitution and influencing factors in HIV infected men who have sex with men (MSM) with access to antiviral therapy (ART) in Guangxi Zhuang Autonomous Region (Guangxi) during 2005-2021.Methods:The data were collected from Chinese Disease Prevention and Control Information System. The study subjects were HIV infected MSM with access to the initial ART for ≥24 weeks in Guangxi from 2005 to 2021 and HIV RNA lower than the detection limit within 24 months. The proportion of infected MSM who had immune reconstitution after ART was calculated. Cox proportional hazard regression model was used to analyze the influencing factors of immune reconstitution. Software SPSS 24.0 was used for statistical analysis.Results:A total of 3 200 HIV infected MSM were enrolled, in whom 15.56 % (498/3 200) had no immune reconstitution, 14.78% (473/3 200) had moderate immune reconstitution, and the rate of complete immune reconstitution was 69.66% (2 229/3 200). The M ( Q1, Q3) of ART time for immune reconstitution was 12 (5, 27) months. Multivariate Cox proportional risk regression model analysis results showed that compared with those with initial ART at age ≥30 years, WHO clinical stage Ⅲ/Ⅳ illness, baseline BMI <18.50 kg/m 2 and baseline CD4 +T lymphocyte (CD4) counts <200 cells/μl, HIV infected MSM with initial ART at age <30 years, WHO clinical stageⅠ/Ⅱ illness, baseline BMI≥24.00 kg/m 2 and baseline CD4 counts ≥200 cells/μl were more likely to have complete immune reconstitution. Conclusions:In the HIV infected MSM in Guangxi, failures to achieve moderate and complete immune reconstitution were observed. Surveillance and ART regimen should be improved for key populations, such as those with older age and low baseline CD4 counts.

Objective:To explore the predictive value of the neutrophil-to-lymphocyte ratio (NLR) combined with blood glucose at admission for a positive blood culture for sepsis.Methods:A single-center retrospective cohort study was conducted. According to the 2016 American Society of Critical Care/European Society of Critical Care Medicine (SCCM/ESICM) and diagnostic criteria for sepsis and septic shock-3.0 (sepsis-3.0), patients with sepsis were admitted to the Emergency Department of Fujian Medical University Union Hospital for more than 24 h from January 2019 to December 2021 were enrolled. Age, gender, sequential organ failure assessment, source of infection, NLR, and blood culture results were recorded. Based on the blood culture results, patients were divided into a blood culture positive group (Gram-positive group, Gram-negative group) and blood culture negative group, and the differences between the groups were compared. The risk factors for a positive blood culture were analyzed using multivariate logistic regression. A receiver operating characteristic analysis was performed for the NLR combined with the blood glucose measurement.Results:A total of 265 patients with sepsis were included, of which 62 were positive in blood culture (15 Gram-positive patients, 37 Gram-negative patients and 10 fungal patients). The positive rate of blood culture was 23.4%. The number of patients with history of diabetes, neutrophil count, procalcitonin, blood glucose, and NLR in the positive blood culture group were significantly higher than those in the negative blood culture group (all P<0.001). Multivariate logistic regression analysis revealed that random admission blood glucose ( OR=1.116, 95% CI: 1.051~1.186, P<0.001) and NLR ( OR=1.039, 95% CI: 1.015~1.064, P=0.001) were independent risk factors for blood culture positivity in sepsis patients. For patients with blood culture positive, and with Gram-negative bacterial bloodstream infections, the AUC of the NLR combined with the admission blood glucose level was 0.819 (95% CI: 0.761-0.877, P<0.001) and 0.871 (95% CI: 0.813-0.928, P<0.001), respectively. Conclusions:The combination of NLR and random admission blood glucose could provide a good predictive value for blood culture positive and gram-negative bacterial bloodstream infections in sepsis patients.

AIM:Clopidogrel and aspirin are com-monly used drugs for the secondary prevention of cerebrovascular disease.Due to drug resistance,their preventive effect is often affected.This article explores the clinical value of clopidogrel and aspirin pharmacogenetic genetic testing in the secondary prevention of ischemic stroke.METHODS:220 pa-tients with mild ischemic stroke or TIA admitted to our hospital from 2021.7 to 2022.9 were included and randomly divided into individualized treatment group and clopidogrel conventional treatment group(control group).The patients were followed up for one year to observe stroke recurrence and hemorrhagic events.RESULTS:(1)Compared with the control group,the recurrence rate of ischemic stroke in the individualized treatment group after 1-year follow-up was slightly lower(5.82％vs.7.92％,P＞0.05),the risk of cerebral hemorrhage was simi-lar,but the risk of other occurrences was increased(6.79％vs.0.99％,P＜0.05).(2)COX regression analy-sis showed that ESRS(HR 2.576,95％CI 1.226-5.413,P=0.013)and history of hypertension(HR 5.517,95％CI 1.624-18.737,P=0.006)were associated with recurrence of ischemic stroke,independent of anti-thrombotic regimen(HR 0.918,95％CI 0.291-2.894,P=0.883).CONCLUSION:Aspirin GPIBA,PTGS1,and ITGB3 gene polymorphisms have limited signifi-cance in guiding antiplatelet medication.Selecting aspirin maintenance therapy for clopidogrel CYP2C19*2*3 allele carriers cannot significantly re-duce the risk of recurrence of minor ischemic stroke and may increase other bleeding risks.COX regression analysis shows that ESRS and history of hypertension are independent risk factors for stroke recurrence.

Abstract OBJECTIVE Linezolid(LZD) is a synthetic oxazolidone antibacterial drug that has activity against most Gram positive bacteria. LZD is widely used in pediatric patients, and its common adverse reactions include gastrointestinal reactions and bone marrow suppression, etc. In recent years, LZD-induced hyperlactatemia has gradually attracted attention. LZD-induced hyperlactatemia can exacerbate the condition of pediatric patients and is associated with high mortality rates in children. However, there is currently a lack of data on the risk factors for LZD-induced hyperlactatemia in pediatric patients. METHODS Therefore, this paper collected and retrospectively analyzed the information of hospitalized pediatric patients who received LZD treatment at the Children's Hospital of Chongqing Medical University from October 2012 to February 2023, including demographic characteristics of pediatric patients and clinical treatment related records, etc. According to the inclusion and exclusion criteria, this paper identified whether the included pediatric patients had developed hyperlactatemia and evaluated the causal relationship between LZD and hyperlactatemia using the Naranjo's Scale. The risk factors were analyzed using univariate and multivariate logistic regression, and the dose-response relationship between risk factors and LZD-induced hyperlactatemia was further analyzed using a restricted cubic spline(RCS) model. RESULTS A total of 331 pediatric patients were included, of which 145 pediatric patients(43.8%) developed LZD-induced hyperlactatemia, including 122 cases of mild hyperlactatemia and 23 cases of severe hyperlactatemia; the causal relationship score of LZD-induced hyperlactatemia was “possibly related” in 87 cases(60.0%) and “highly likely related” in 58 cases(40.0%). The median age of pediatric patients was 3(0.92, 9) years old, with 55.29% males, 25.38% patients with liver disease, 8.76% pediatric patients with kidney disease, and 36.56% pediatric patients with cardiovascular disease; the median number of treatment days for pediatric patients receiving LZD was 13(8, 22) d, with pediatric patients with hyperlactatemia having a longer median number of LZD treatment days than those without hyperlactatemia[16(10, 28) vs 11(7, 18)]; 41.09% of pediatric patients used P-glycoprotein inducers in combination, with more pediatric patients(57.4%) experiencing hyperlactatemia; 53.47% of pediatric patients used P-glycoprotein inhibitors in combination; the median values of lactic acid baseline, creatinine baseline, and baseline estimated glomerular filtration rate(eGFR) were 0.92(0.80, 0.92)mmol·L-1, 26(18.25, 34.90) μmol·L-1, 179.97(137.23, 222.70)mL·min-1·(1.73 m)-2, respectively. Multivariate logistic regression analysis showed that pediatric patients received longer LZD treatment duration(OR=1.026, P=0.004), and the combination of P-glycoprotein inducers(OR=2.023, P=0.004), higher lactic acid baseline levels(OR=2.408, P=0.022), and lower eGFR(OR=0.997, P=0.047) were independent risk factors for LZD-induced hyperlactatemia. The RCS model showed that as the number of days of LZD treatment increases, the risk of LZD-induced hyperlactatemia increased nonlinearly(P-non-linear=0.041); when the lactic acid baseline value was -1, the risk of LZD-induced hyperlactatemia dramatically increased as the lactic acid baseline value increased, when it was >0.92 mmol·L-1, the risk of LZD-induced hyperlactatemia slowly increased as the lactic acid baseline value increased(P-non-linear=0.013). CONCLUSION This study explores for the first time the risk factors of LZD-induced hyperlactatemia in pediatric patients, including the impact of the interaction between LZD and drugs that affect mitochondrial function, P-glycoprotein inducers, and P-glycoprotein inhibitors on hyperlactatemia. RCS models are used to analyze the dose-response relationships between LZD treatment days, lactic acid baseline values, and the occurrence of LZD-induced hyperlactatemia. When LZD is combined with P-glycoprotein inducers(mainly isoniazid, rifampicin, and ethambutol), the risk of LZD-induced hyperlactatemia increases, and its related mechanisms still need further research. In addition, pediatric patients with renal insufficiency may need to adjust the LZD dosage appropriately to avoid the occurrence of hyperlactatemia. In conclusion, when pediatric patients receive LZD treatment, attention should be paid to risk factors such as lactic acid baseline value, duration of LZD use, combined use of P-glycoprotein inducers, and renal dysfunction, in order to prevent the occurrence of LZD-induced hyperlactatemia based on the pediatric patient's treatment needs.

Objective:To analyze the trend of late-diagnosis of HIV-infected men who have sex with men (MSM) before and after the AIDS Conquering Project in Guangxi Zhuang Autonomous Region (Guangxi) and its influencing factors, in order to find out the population groups that need priority intervention at the present stage.Methods:The HIV-infected MSM in Guangxi from 2005-2021 were selected from the National Integrated HIV/AIDS Control and Prevention Data System. The Joinpoint 4.9.1.0 software was used to test the time trend of late-diagnosis and non-late-diagnosis cases, and logistic regression was applied to analyze the factors influencing the proportion of late-diagnosis at each stage.Results:From 2005 to 2021, 5 764 HIV-infected MSM were reported in Guangxi from 2005 to 2021, with an overall late-diagnosis of 28.45% (1 640 cases). Under the 2015 baseline data as the boundary, the proportion of late-diagnosis cases showed a trend of sharp decline followed by stabilization from 2005 to 2015, average annual percent change= -6.90% ( P<0.001). The effect of factors such as resident population, occupation as a farmer or worker, and sample originating from medical consultation on late-diagnosis changed considerably before and after the implementation of the project, and the factors influencing late-diagnosis at this stage were age, resident population, occupation as a farmer, worker or student. The factors influencing late-diagnosis at this stage are age, resident population, and occupation as a farmer, worker and a student. Conclusions:The proportion of late diagnosis cases of HIV-infected MSM in Guangxi decreased significantly before and after the project. However, late-diagnosis should not be neglected and precise prevention and control should be carried out for the resident population, farmers, workers or students.

Objective:To explore influence on physical development of children aged 18 months from HIV-positive mothers for prevention mother to child transmission of HIV (PMTCT) in Guangxi Zhuang autonomous region, and provide evidence for the improvement PMTCT program.Methods:This retrospective case control study was conducted in 554 HIV negative infants aged 18 months whose HIV positive mothers had received PMTCT services reported through PMTCT system database from January 1, 2010 to December 31, 2017 and 1 109 healthy infants born in 2017, whose mothers were healthy, in Lingshan, Luzhai, and Hengxian counties, ranking top three counties with high HIV infection prevalence, in Guangxi. PMTCT data and physical development data such as height, weight and head circumference of children aged 18 months were collected. The physical dysplasia in the infants was defined as at least one of the three main indicators of height, weight and head circumference below the normal range.Results:The number of HIV-positive mother and their infants in the case group were 667 and 554 respectively, and the PMTCT rates were 91.15 % (608/667) and 96.57 % (535/554) respectively. HIV positive rate, mortality rate and mother to child transmission rate of the infants aged 18 months were 1.44 % (8/554), 3.07 % (17/554) and 1.91 % (8/418) respectively, and the physical examination results of the infants aged 18 months showed that the physical dysplasia rate was 30.51 % (169/554). Among the 1 109 infants in the control group, the physical dysplasia rate was 9.83 % (109/1 109). The difference between the case group and the control group was significant ( P<0.01). Conclusion:The PMTCT rates of HIV positive mother and their children were more than 90.00 %, respectively. However, poor physical development rate of infants aged 18 months were more than 30.00 %. The possible influence of PMTCT on physical development of the infants aged 18 months of HIV positive mother’s needs to be further studied.

Objective:To understand the characteristics and associated factors of newly reported HIV/AIDS cases with non-marital or non-commercial heterosexual transmission, in Guangxi Zhuang Autonomous Region (Guangxi), 2015-2018.Methods:Information of newly reported HIV/AIDS cases aged ≥18 years in Guangxi between 2015 and 2018 was collected from the National Comprehensive HIV/AIDS Information System. Unconditional logistic regression model was used to access those factors that were associated with HIV infections through non-marital or non-commercial heterosexual contact.Results:Between 2015 and 2018, a total number of 35 497 HIV/AIDS cases, aged ≥18 years were newly reported in Guangxi. Among them, 32 648 (92.0 %) were infected heterosexually while 10 500 were infected through non-marital or non-commercial heterosexual behavior. Non-marital or non-commercial heterosexual transmission accounted for 29.6 % (10 500/35 497) of the newly reported HIV/AIDS cases, and 32.2 % (10 500/32 648) of those with heterosexual transmission. Males counted for 53.5 % (5 617/10 500) of non-marital or non-commercial heterosexual transmission and males to females ratio was 1.2∶1 (5 617∶4 883). Those married or had regular sexual partners counted for 55.9 % (5 873/10 500). Commercial heterosexual transmission appeared the main mode of HIV transmission for males (64.4 %,16 516/25 633) while main mode for females was non-marital or non-commercial heterosexual transmission and counted for 49.5 % (4 883/9 864). Results from the multivariate logistic regression analysis showed that adjusted OR of female HIV/AIDS infected HIV via non-marital or non-commercial heterosexual transmission, was 3.98 times (95 %CI: 3.78-4.20) hight than that of males. Among the group aged<50 years and the aged 50-59 years, the adjusted ORs were 1.35 times (95 %CI: 1.27-1.44) and 1.13 times (95 %CI: 1.05-1.21) hight than that of aged ≥60 years. Those who were single/divorced/widowed, the adjusted OR was 1.53 times (95 %CI: 1.45-1.61) hight than that of those married/regular partners. Those with junior high school education, high school education and above the adjusted ORs were 1.22 times (95 %CI: 1.16-1.29) and 1.18 times (95 %CI: 1.10-1.27), compared to those only with education levels of primary school or below. Conclusions:The number of HIV/AIDS cases via non-marital or non-commercial heterosexual transmission accounted for nearly 30.0 % of all the routes of HIV transmission in Guangxi, 2015-2018. Female, aged<60 years old, single/divorced/widowed and having had junior and above high school education etc., appeared as risk factors on non-marital or non-commercial heterosexual transmission, among newly reported HIV/AIDS in Guangxi.

Objective: To understand the characteristics of HIV/AIDS epidemic in Guangxi Zhuang Autonomous Region (Guangxi) with a purpose to accurately provide scientific basis for prevention and control measures, 2010-2017. Methods: Data were retrieved from case reporting cards of Guangxi during 2010 to 2017 through National HIV/AIDS Comprehensive Response Information Management System. Data was analyzed using epidemiological methods such number of cases, proportion and rate. χ² test was used for statistical analysis. Results: The HIV positive rate was 12.53 per ten thousand (85 182/67 959 000) in Guangxi during 2010 to 2017. The number of newly diagnosed HIV/AIDS cases and the number of death yearly respectively increased by 22.34%(2 602/11 648) and 32.83% (952/2 900) in 2011 compared with 2010, and both showed a six-year continuous downward trend (the number of newly diagnosed cases respectively 12 229 cases, 10 877 cases, 9 460 cases, 9 190 cases, 8 848 cases, 8 680 cases, and the number of death respectively 3 888 cases, 3 316 cases, 2 914 cases, 2 717 cases, 2 595 cases, 2 600 cases) from 2012 to 2017. But proportion of late discovery remained above 50.00% (50.53%-57.06%) for eight-years continuously. The ratio of male and female was 2.47 ∶ 1 (60 639/24 543). The ratio of males and females aged 50 and over was 2.71∶1 (28 654/10 557). Proportion of the cases in 25-49 years old group and 50 years old group accounting for 47.40%(40 377/85 182) and 46.03% (39 211/85 182) respectively. The occupation was farmers accounting for 68.40% (58 262/85 182), housekeeping, housework and unemployment accounting for 11.21% (9 546/85 182), student accounting for 0.86% (729/85 182). Heterosexual transmission accounted for 90.60% (77 171/85 182, homosexual transmission accounted for 3.13% (2 669/85 182), injection drug use transmission accounted for 4.60%(3 924/85 182) and mother-to-child transmission accounted for 0.73% (619/85 182). Conclusions The number of newly diagnosed cases and the number of death yearly showed a continuous downtrend for six-years from 2012 to 2017. However, proportion of late discovery remained above 50.00% for eight-years. The major route of infection was heterosexual transmission. With the change of HIV/AIDS newly epidemic mode in Guangxi, there are many new challenges for HIV/AIDS prevention and control work. Strategy of targeted intervention modes should be innovated for a new breakthrough.

Objective To explore the effects of inhospital emergency process ~engineering for patients with acute poisoning.Methods Emergency Department of the Affiliated Hospital of Hangzhou Normal University implemented inhospital poisoning emergency process reengineering in March 2016.This implementation optimized original emergency process and applied it in patients with acute poisoning beginning with 6 aspects including refining precheck patients,assessment of poisoning emergency response group,fast gastrolavage,transportation,gastrolavage combined with blood purification group rapid preparation,emergency intensive care unit preparation.We compared the rescue efficiency of patients with acute poisoning before (from March 2015 to February 2016) and after (from March 2016 to February 2017) process reengineering.Results After process reengineering,the time from being admitted to hospital to beginning gastrolavage and the duration of gastrolavage was (8.91 ± 5.29)min and (31.86 ± 8.42)min respectively shorter than those before process reengineering with significant differences (t=3.397,4.028;P ＜ 0.01).After process reengineering,the time from being admitted to hospital to opening blood purification tubes (176.59 ± 88.73)min and from being admitted to hospital to starting blood perfusion (229.35 ± 108.79)min were significantly sooner than those before process reengineering (t=3.600,3.550;P ＜ 0.01).Conclusions The inhospital emergency process reengineering is scientific and convenient.It is propitious to improve rescue efficiency of patients with acute poisoning.

Objective To establish and analyze a mouse model of Staphylococcus aureus?induced arthritis ( Staphy?lococcus aureus septic arthritis, SA) , and provide an animal model for arthritis mechanism research and drug development. Methods Mice were immunosuppressed with cyclophosphamide, then intravenously inoculated with Staphylococcus au?reus. The gross characteristics of the joints were observed, the arthritis indexes were analyzed, and the pathological scores of the model mice were evaluated. Results From the first day after bacterial inoculation, the mouse joints were swollen. Pathological examination revealed lesions varying from mild and disarranged joint synovial hyperplasia to synovial thickening and intra?articular invasion, and increased neutrophil infiltration. Conclusions A mouse model of Staphylococcus aureus?induced arthritis is successfully established in this study. This model can be developed in a relatively short time, can not only simulate the clinical symptoms and signs and disease progression of human arthritis, but also to a certain extent reflects the etiology, infection and immunological mechanisms of human arthritis.